Thoracolumbar Spinal Stabilization with Three Dimensional-Printed Drill Guides and Pre-Contoured Polyaxial Bone Plates.

OBJECTIVE: The aim of this study was to report new preoperative and intraoperative techniques performed for canine thoracic or lumbar spine kyphosis stabilization using three-dimensional-printed patient-specific drill guides, polyaxial titanium bone plates and drill stops, and to determine the accuracy of screw placement using these techniques. STUDY DESIGN: Retrospective study, five client-owned dogs. RESULTS: Three-dimensional-printed patient-specific drill guides and drill stops allowed safe drilling and screw placement in all of the cases, with (i) 84% of the screws graded as I (ideal placement) and 16% as IIa, IIIa or IIIb according to the modified Zdichavsky classification (partial penetration of medial pedicle wall, partial penetration of lateral pedicle wall and full penetration of lateral pedicle wall respectively), (ii) mean mediolateral deviation of ± 4.06 degrees (standard deviation: 8.21 degrees) compared to planned trajectories and (iii) variation in screw depth of ± 2.29mm (standard deviation: 3.07mm) compared to planned depth. CONCLUSION: We believe that the techniques presented here for thoracic spinal stabilization in dogs show promise; they allowed safe placement of screws along planned trajectories and depth; they also removed the need to use polymethylmethacrylate, while the use of titanium offers the possibility to repeat magnetic resonance imaging in these cases with chronic spinal conditions.

Lateralization of the diaphragm for thoracic wall reconstruction in a dog.

CASE DESCRIPTION: A 7-year-old 35-kg (77-lb) neutered male Labrador Retriever was evaluated because of a 1-month history of a rapidly growing mass associated with the right caudal aspect of the thoracic wall. CLINICAL FINDINGS: CT examination revealed an aggressive, osteolytic mass lesion centered around the ventral aspect of the right ninth rib with osteolysis of that rib and focal invasion into the right external abdominal oblique muscle. Preoperative cytologic and histologic findings were most consistent with a chondrosarcoma. TREATMENT AND OUTCOME: The mass and the eighth, ninth, and tenth ribs were resected, and thoracic wall reconstruction was performed with a novel surgical technique involving lateralization of the diaphragm. The dog recovered rapidly and without complications other than a small seroma; no paradoxical chest movement developed, and the cosmetic outcome was good. An excellent quality of life was reported after surgery until the dog was euthanized because of underlying disease progression 6 months later. CLINICAL RELEVANCE: Diaphragmatic lateralization was a simple method of caudal thoracic wall reconstruction that had good clinical results in this case. Research is needed to further assess the safety, reliability, and potential complications of this procedure in dogs.

Colored Indicator Undergloves Increase the Detection of Glove Perforations by Surgeons During Small Animal Orthopedic Surgery: A Randomized Controlled Trial.

OBJECTIVE: To determine whether use of colored indicator gloves affects perforation detection rate and to identify risk factors for glove perforation during veterinary orthopedic surgery. STUDY DESIGN: Prospective randomized controlled trial. SAMPLE POPULATION: 574 double pairs of gloves worn during 300 orthopedic surgical procedures (2,296 gloves). METHODS: Primary and assistant surgeons double-gloved for all orthopedic surgical procedures. Type of inner glove (standard or colored indicator) was randomized for the first 360 double pairs of gloves worn by surgeons during 180 procedures. Perforations detected by surgeons were recorded and gloves changed if requested. For a further 120 procedures, indicator gloves were used exclusively. All gloves were leak-tested after surgery to identify perforations. Association between potential risk factors and perforation was explored using multivariate logistical regression analysis. RESULTS: Glove perforations occurred during 43% of surgeries with a mean of 2.3 holes/surgery. Inner gloves were intact in 63% of glove pairs where an outer perforation occurred. Intraoperative perforation detection was improved when colored indicator gloves were worn (83% sensitivity) vs. standard gloves (34% sensitivity; P<.001). Independent risk factors for perforation were placement of plates and/or screws (P=.001; OR=2.4; 95% CI, 1.4-4.0), placement of an external skeletal fixator (P=.002; OR=7.0; 95% CI, 2.1-23.8), use of orthopedic wire (P=.011; OR=2.4; 95% CI, 1.2-4.7), and primary surgeon being board-certified (P=.016; OR=1.9; 95% CI, 1.1-3.1). CONCLUSION: Increased surgeon recognition of glove perforations through use of colored indicator gloves enables prompt change of gloves if perforation occurs and may reduce potential contamination of the surgical site.